The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Juha Hernesniemi - One of the best experts on this subject based on the ideXlab platform.
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unedited Microneurosurgery of a pineal region neuroepithelial cyst
Surgical Neurology International, 2019Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Neuroepithelial cysts are benign, well-circumscribed, nonenhancing CSF-like masses that might virtually present in any intracranial location. Common locations are the frontal lobe, thalamus, midbrain and pons, vermis, the lateral and fourth ventricles, and the choroid fissure (Choroid fissure cysts). Usually asymptomatic, cysts in the posterior fossa have been reported to cause cranial nerve palsies, focal brainstem dysfunction, and hydrocephalus. Supratentorial cysts might cause seizures or focal motor and/or sensory deficits. Histopathological examination reveals that neuroepithelial cysts are lined by ependymal (columnar epithelium) or choroid plexus cells (low cuboidal epithelium). The differential diagnosis includes enlarged perivascular spaces, infectious cyst-neurocysticercosis, porencephalic cyst, and arachnoid cyst. Case Description A patient with a symptomatic histologically confirmed pineal region neuroepithelial cyst underwent park bench position and a right supracerebellar infratentorial approach. The pineal region was accessed over the right cerebellar hemisphere and the lesion was identified after a lateral opening of the quadrigeminal cistern. After a careful dissection of the lesion, the cyst was pulled out with long ring microforceps and long sharp bipolar forceps; both assisted by a thumb-regulated suction tube. A complete lesion was removed in a piece and meticulous attention was paid to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful. The patient underwent rehabilitation without recurrence of the lesion. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery into the pineal region for this very rarely documented pineal region neuroepithelial cyst. Videolink http://surgicalneurologyint.com/videogallery/pineal-cyst-4.
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intracranial dural arteriovenous fistula Microneurosurgery basics and tricks
2019Co-Authors: Anna Piippo, Mardjono Tjahjadi, Juha HernesniemiAbstract:Intracranial dural arteriovenous fistulas (DAVFs) are acquired lesions characterized by a region of abnormal arteriovenous fistulous connection within the dura. DAVFs contribute to 10–15% of all AVM intracranially as reported by Newton et al. from 1969 [1]. In common population the probable rates were 0.15–0.29 per 100,000 people per year [2, 3]. Median age of DAVF patients is between 50 and 60 years, but it may present at any age [4, 5].
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Unedited Microneurosurgery of a pineal region ependymoma.
Surgical Neurology International, 2018Co-Authors: Joham Choque-velasquez, Juha HernesniemiAbstract:Background: Ependymomas are rarely located in the pineal region. The 2016 WHO classification of tumors of the central nervous system includes five ependymal tumors, the grade I subependymoma and mixopapillary ependymoma, the grade II ependymoma, the grade II-III ependymoma RELA fusion-positive, and the grade III anaplastic ependymoma. However, this grading system has been controversial with respect to its reproducibility and clinical significance and it is estimated that further studies of the molecular characteristics of ependymoma will provide more precise and objective classification. Herein, we present an unedited Microneurosurgery of a gross total removed WHO grade II ependymoma. Case Description: A patient with a histologically confirmed WHO grade II ependymoma underwent a sitting praying position and a supracerebellar infratentorial paramedian approach. Under high magnification, the pineal region was accessed over the right cerebellar hemisphere. A tight dorsal membrane of the quadrigeminal cistern was opened laterally with microscissors. Tissue samples were obtained with ring microforceps for histological study. Internal debulking of the tumor was performed with the combination of the suction tube and bipolar forceps aiming to open the posterior wall of the third ventricle. Concentric retraction of the tumor with ring forceps was associated with medial and inferior dissection of its cleavage plane with the thumb-regulated suction tube. Similarly, the lateral border of the lesion was dissected with a combination of the suction tube and bipolar forceps. Once, the tumor was detached from the surrounding tissue, soft but continuous traction with ring forceps was required to pull out this lesion in a single piece. Small remnants were removed as well and the apparent origin zone of the tumor was detached with bipolar forceps. Meticulous attention was paid for the hemostasis and few minutes were considered to observe any bleeding site. Finally, some pieces of surgicel covered small bleeding dots. The postoperative course was uneventful with only slight double vision that improved gradually. The patient did not receive radiochemotherapy and is alive and free of recurrence >10 years after surgery. Conclusion: This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery into the pineal region for this very rarely documented pineal region ependymoma. Videolink: http://surgicalneurologyint.com/videogallery/pineal-tumor-4/.
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unedited pineal cyst Microneurosurgery
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Pineal cysts are benign lesions of the pineal gland without a clear etiology. Currently, different approaches are described to deal with pineal region lesions and particularly with pineal cysts. Although endoscopic procedures are becoming more frequent, some technical advantages of the microsurgical resection still make it the gold standard. Our aim was to demonstrate the efficiency and safety of our microsurgical technique into deep brain territories under the principle "simple, clean, and preserving the normal anatomy." Herein, we present an unedited Microneurosurgery of a histologically confirmed large benign pineal cyst. Case description A patient with antidepressant medication, psychotic attacks, memory problems, and progressively intense headache along the last months underwent sitting praying position and supracerebellar infratentorial paramedian approach. Under high magnification, the pineal region was accessed over the right cerebellar hemisphere. A lateral focused opening of the quadrigeminal cistern and the posterior wall of the pineal cyst were followed by partial aspiration of the cystic content. Small vessels running around the cyst were carefully dissected, and few of those attached to the wall were coagulated and cut. After careful devascularization of the lesion, the cyst was detached and pulled out using soft and continuous traction with a long ring microforceps in the right hand and thumb-controlled suction tube in the left one. The final steps included meticulous attention to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful and the patient improved dramatically with resolution of the headache and progressive reduction of psychiatric medication. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe pineal cyst surgery. Videolink http://surgicalneurologyint.com/videogallery/pineal-cyst/.
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unedited Microneurosurgery of a cavernous malformation of the pineal region
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Cavernous malformations are low-flow vascular malformations comprised of clusters of dilated sinusoidal channels lined with endothelial cells. The tortuous blood vessels also called vascular caverns lack muscular and elastic layers, and are filled by blood at different stages of thrombosis. Hemosiderin and gliosis often surround cavernomas. However, no neural tissue is present inside the lesion. Magnetic resonance images of cavernomas reveal a pathognomonic popcorn appearance produced by multiple small hemorrhages. Developmental venous anomalies are associated in around 30% of the cases. Cavernomas are very prevalent lesions ranging from 0.4 to 0.8% of the population. However, those located in the pineal region are very rare. Herein, we present the microsurgical treatment of a histologically confirmed cavernous malformation of the pineal region. Case description A 33-year-old patient with a pineal region cavernoma and progressive hydrocephalus underwent right supracerebellar infratentorial paramedian approach in a sitting praying position. The surgical planning did not require neuronavigation, but anatomical landmarks for the proper approach. Under high magnification, the pineal region was accessed over the superior cerebellar surface. After a focused lateral opening of the dorsal membrane of the quadrigeminal cistern, small vessels running in the posterior wall of the third ventricle were carefully dissected. A yellowish hemosiderin staining tissue allowed us to recognize the vicinity of the lesion. A small cottonoid delimitated the posterior border of the malformation, nonetheless, the superior limits underwent microdissection to release some cerebrospinal fluid from the third ventricle. A precise marginal dissection with bipolar forceps, microdissectors, and a thumb-regulated suction tube encircled the lesion. Gently traction of the lesion with ring microforceps associated further detachment of the cavernoma with the suction tube. Cotton dissection and water dissection technique were useful as well. A piecemeal resection, which is indicated in lesions with a deep and eloquent location, allowed us a complete removal of the cavernoma. Accurate hemostasis and continuous saline irrigation maintained a clean surgical field along the procedure. The gliotic tissue was left behind to prevent damage of the surrounding structures. Under endoscopic vision, remnants in the lower margins of the operative field were carefully evaluated. Finally, the surgical area was flushed with saline irrigation to detect any bleeding, and a small piece of tachosil was placed over the cavity. The postoperative course was uneventful. The hydrocephalus resolved after surgery and it did not require any further procedure. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author Juha Hernesniemi considers essential when performing an efficient and safe surgery for cavernous malformation of the pineal region. Videolink http://surgicalneurologyint.com/videogallery/iii-ventricle-cavernoma/.
Joham Choquevelasquez - One of the best experts on this subject based on the ideXlab platform.
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unedited Microneurosurgery of a pineal region neuroepithelial cyst
Surgical Neurology International, 2019Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Neuroepithelial cysts are benign, well-circumscribed, nonenhancing CSF-like masses that might virtually present in any intracranial location. Common locations are the frontal lobe, thalamus, midbrain and pons, vermis, the lateral and fourth ventricles, and the choroid fissure (Choroid fissure cysts). Usually asymptomatic, cysts in the posterior fossa have been reported to cause cranial nerve palsies, focal brainstem dysfunction, and hydrocephalus. Supratentorial cysts might cause seizures or focal motor and/or sensory deficits. Histopathological examination reveals that neuroepithelial cysts are lined by ependymal (columnar epithelium) or choroid plexus cells (low cuboidal epithelium). The differential diagnosis includes enlarged perivascular spaces, infectious cyst-neurocysticercosis, porencephalic cyst, and arachnoid cyst. Case Description A patient with a symptomatic histologically confirmed pineal region neuroepithelial cyst underwent park bench position and a right supracerebellar infratentorial approach. The pineal region was accessed over the right cerebellar hemisphere and the lesion was identified after a lateral opening of the quadrigeminal cistern. After a careful dissection of the lesion, the cyst was pulled out with long ring microforceps and long sharp bipolar forceps; both assisted by a thumb-regulated suction tube. A complete lesion was removed in a piece and meticulous attention was paid to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful. The patient underwent rehabilitation without recurrence of the lesion. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery into the pineal region for this very rarely documented pineal region neuroepithelial cyst. Videolink http://surgicalneurologyint.com/videogallery/pineal-cyst-4.
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unedited pineal cyst Microneurosurgery
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Pineal cysts are benign lesions of the pineal gland without a clear etiology. Currently, different approaches are described to deal with pineal region lesions and particularly with pineal cysts. Although endoscopic procedures are becoming more frequent, some technical advantages of the microsurgical resection still make it the gold standard. Our aim was to demonstrate the efficiency and safety of our microsurgical technique into deep brain territories under the principle "simple, clean, and preserving the normal anatomy." Herein, we present an unedited Microneurosurgery of a histologically confirmed large benign pineal cyst. Case description A patient with antidepressant medication, psychotic attacks, memory problems, and progressively intense headache along the last months underwent sitting praying position and supracerebellar infratentorial paramedian approach. Under high magnification, the pineal region was accessed over the right cerebellar hemisphere. A lateral focused opening of the quadrigeminal cistern and the posterior wall of the pineal cyst were followed by partial aspiration of the cystic content. Small vessels running around the cyst were carefully dissected, and few of those attached to the wall were coagulated and cut. After careful devascularization of the lesion, the cyst was detached and pulled out using soft and continuous traction with a long ring microforceps in the right hand and thumb-controlled suction tube in the left one. The final steps included meticulous attention to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful and the patient improved dramatically with resolution of the headache and progressive reduction of psychiatric medication. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe pineal cyst surgery. Videolink http://surgicalneurologyint.com/videogallery/pineal-cyst/.
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unedited Microneurosurgery of a cavernous malformation of the pineal region
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Cavernous malformations are low-flow vascular malformations comprised of clusters of dilated sinusoidal channels lined with endothelial cells. The tortuous blood vessels also called vascular caverns lack muscular and elastic layers, and are filled by blood at different stages of thrombosis. Hemosiderin and gliosis often surround cavernomas. However, no neural tissue is present inside the lesion. Magnetic resonance images of cavernomas reveal a pathognomonic popcorn appearance produced by multiple small hemorrhages. Developmental venous anomalies are associated in around 30% of the cases. Cavernomas are very prevalent lesions ranging from 0.4 to 0.8% of the population. However, those located in the pineal region are very rare. Herein, we present the microsurgical treatment of a histologically confirmed cavernous malformation of the pineal region. Case description A 33-year-old patient with a pineal region cavernoma and progressive hydrocephalus underwent right supracerebellar infratentorial paramedian approach in a sitting praying position. The surgical planning did not require neuronavigation, but anatomical landmarks for the proper approach. Under high magnification, the pineal region was accessed over the superior cerebellar surface. After a focused lateral opening of the dorsal membrane of the quadrigeminal cistern, small vessels running in the posterior wall of the third ventricle were carefully dissected. A yellowish hemosiderin staining tissue allowed us to recognize the vicinity of the lesion. A small cottonoid delimitated the posterior border of the malformation, nonetheless, the superior limits underwent microdissection to release some cerebrospinal fluid from the third ventricle. A precise marginal dissection with bipolar forceps, microdissectors, and a thumb-regulated suction tube encircled the lesion. Gently traction of the lesion with ring microforceps associated further detachment of the cavernoma with the suction tube. Cotton dissection and water dissection technique were useful as well. A piecemeal resection, which is indicated in lesions with a deep and eloquent location, allowed us a complete removal of the cavernoma. Accurate hemostasis and continuous saline irrigation maintained a clean surgical field along the procedure. The gliotic tissue was left behind to prevent damage of the surrounding structures. Under endoscopic vision, remnants in the lower margins of the operative field were carefully evaluated. Finally, the surgical area was flushed with saline irrigation to detect any bleeding, and a small piece of tachosil was placed over the cavity. The postoperative course was uneventful. The hydrocephalus resolved after surgery and it did not require any further procedure. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author Juha Hernesniemi considers essential when performing an efficient and safe surgery for cavernous malformation of the pineal region. Videolink http://surgicalneurologyint.com/videogallery/iii-ventricle-cavernoma/.
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unedited Microneurosurgery of a mixed germ cell tumor of the pineal region
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Germ cell tumors comprise a heterogeneous group of neoplasms, classified as germinomas and nongerminomatous germ cell tumors based on clinicopathological features. The nongerminomatous group of tumors includes embryonal carcinoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma, mature and immature teratoma, and mixed germ cell tumors with more than one element. While germinomas are radiation-sensitive tumors, all other tumors have less response to radiotherapy, and it is suggested that gross total resection improves their overall survival and tumor-free survival rates. Herein, we present the microsurgical management of a histologically confirmed mixed-germ cell of the pineal region. Case description A patient with a mixed germ cell tumor underwent sitting praying position and midline supracerebellar infratentorial approach. After opening of the dura, a midline cerebellar vein was coagulated and cut, and the pineal region was accessed over the superior cerebellar surface. A tight reactive dorsal membrane of the quadrigeminal cistern was widely opened with subsequent evaluation of the neurovascular structures by intraoperative angiography. Under high microsurgical magnification between both basal veins, the dorsal wall of the fibrotic and solid tumor was coagulated and opened aiming an internal debulking of the lesion. Water dissection and cotton dissection were useful tools to separate the lateral borders of the tumor from the surroundings. Bipolar coagulation was helpful shrinking the tumor as well. The superior borders of the lesion, firmly attached to the roof of the third ventricle, required a careful evaluation. Ring microforceps in the right hand and thumb-regulated suction tube in the left one allowed us to pull out the tumor in a piece under soft and continuous traction with dissection of the cleavage plane. The superior attachment of the tumor was coagulated and cut. Finally, bipolar coagulation and small pieces of surgicel ensured a proper hemostasis. Postoperatively, the patient had a partial gaze palsy that improved gradually. The patient underwent adjuvant radiochemotherapy and currently is alive, free of tumor recurrence >12 years after surgery. Conclusion This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery for a mixed germ cell tumor. Videolink http://surgicalneurologyint.com/videogallery/pineal-tumor-5.
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unedited Microneurosurgery of a solitary fibrous tumor of the pineal region
Surgical Neurology International, 2018Co-Authors: Joham Choquevelasquez, Juha HernesniemiAbstract:Background Solitary fibrous tumor/hemangiopericytoma is a new combined entity introduced in the 2016 World Health Organization classification of tumors of the central nervous system for grade I-III soft-tissue tumors. While grades II and III present more aggressive course and might require adjuvant radiochemotherapy, grade I tumors have a good outcome after gross total resection. In this video-abstract, we present an unedited Microneurosurgery of a histologically confirmed benign solitary fibrous tumor of the pineal region performed by a senior author (JH). Our aim is to demonstrate the efficiency and safety of our microsurgical technique into deep brain territories under the principle "simple, clean, and preserving the normal anatomy." For this, a paramedian supracerebellar infratentorial approach and a proper praying sitting position are essential. Case Description A patient with a history of slow progressive hydrocephalus was placed in a sitting praying position. The pineal region was accessed over the right cerebellar hemisphere following a right paramedian supracerebellar infratentorial approach. The lesion identified after a lateral opening of the quadrigeminal cistern followed partial debulking. Small vessels running on the surface of the tumor were coagulated and cut. After a careful dissection and devascularization of the lesion, the tumor was pulled out using long ring microforceps and long sharp bipolar forceps as well. The final steps included detachment of some tumoral remnants from the internal cerebral veins and meticulous attention to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful with only slight and occasionally double vision. The patient is alive and free of recurrence almost 4 years after surgery. Conclusion This unedited video offers all detailed aspects that a neurosurgeon like senior author JH considers essential when performing an efficient and safe surgery into the pineal region for this very rarely documented solitary fibrous tumor. Videolink http://surgicalneurologyint.com/videogallery/pineal-tumor.
Shunro Endo - One of the best experts on this subject based on the ideXlab platform.
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impact of neuronavigation and image guided extensive resection for adult patients with supratentorial malignant astrocytomas a single institution retrospective study
Minimally Invasive Neurosurgery, 2004Co-Authors: Masanori Kurimoto, Hironaga Kamiyama, Nobuhisa Matsumura, Nakamasa Hayashi, Shoichi Nagai, Takashi Asahi, Yutaka Hirashima, Takashi Shibata, Shunro EndoAbstract:Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional Microneurosurgery and the other 34 were treated with conventional Microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age (<65), grade 3, preoperative KPS (≥80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (≥80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs.10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3% vs. 38.2%, p<0.05). Neurological deterioration occurred in 4 of 42 (9.5%) and in 6 of 34 (17.6%) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.
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impact of neuronavigation and image guided extensive resection for adult patients with supratentorial malignant astrocytomas a single institution retrospective study
Minimally Invasive Neurosurgery, 2004Co-Authors: Masanori Kurimoto, Hironaga Kamiyama, Nobuhisa Matsumura, Nakamasa Hayashi, Shoichi Nagai, Takashi Asahi, Yutaka Hirashima, Takashi Shibata, Shunro EndoAbstract:Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional Microneurosurgery and the other 34 were treated with conventional Microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age ( /= 80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (>/= 80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.
Nobuhisa Matsumura - One of the best experts on this subject based on the ideXlab platform.
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a new bayonet spring microsurgical instrument handle with a bar for Microneurosurgery
Surgical Neurology International, 2012Co-Authors: Nobuhisa MatsumuraAbstract:BACKGROUND The bayonet-shaped spring surgical instrument is essential and perhaps the most important tool in Microneurosurgery. It is needed to be handled gently, and so stable handling to the spring tension of the long instrument handle is necessary for fine action in narrow and deep operative fields under an operating microscope. METHODS A bayonet spring microsurgical instrument handle with a bar as a stabilizer is presented for facilitating delicate microsurgical manipulations stably in Microneurosurgery. The bar with the handle is a metric projection. The grip of this instrument is a modified writing grasp, which is composed of writing grasp and sandwiching a lateral-projected bar with handle between the medial side of the index finger and the lateral side of the middle finger. Then, this bar as a stabilizer of the instrument is suitable to fix it. RESULTS Microneurosurgical operations using this instrument system were performed. This was advantageous to stabilize the instrument in deep and narrow operative fields, to be sensitive to move its functional tips by fingertips, and to reduce unwanted movements under an operating microscope. This was disadvantageous to limit the rotational movement within fingers. There were no complications. CONCLUSION This handle would provide a steady and balanced grip to ensure precise manipulation of the functional tips of the bayonet instrument for Microneurosurgery. It may be useful particularly for the beginners or for the non-dominant hand of microsurgeons.
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impact of neuronavigation and image guided extensive resection for adult patients with supratentorial malignant astrocytomas a single institution retrospective study
Minimally Invasive Neurosurgery, 2004Co-Authors: Masanori Kurimoto, Hironaga Kamiyama, Nobuhisa Matsumura, Nakamasa Hayashi, Shoichi Nagai, Takashi Asahi, Yutaka Hirashima, Takashi Shibata, Shunro EndoAbstract:Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional Microneurosurgery and the other 34 were treated with conventional Microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age (<65), grade 3, preoperative KPS (≥80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (≥80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs.10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3% vs. 38.2%, p<0.05). Neurological deterioration occurred in 4 of 42 (9.5%) and in 6 of 34 (17.6%) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.
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impact of neuronavigation and image guided extensive resection for adult patients with supratentorial malignant astrocytomas a single institution retrospective study
Minimally Invasive Neurosurgery, 2004Co-Authors: Masanori Kurimoto, Hironaga Kamiyama, Nobuhisa Matsumura, Nakamasa Hayashi, Shoichi Nagai, Takashi Asahi, Yutaka Hirashima, Takashi Shibata, Shunro EndoAbstract:Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional Microneurosurgery and the other 34 were treated with conventional Microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age ( /= 80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (>/= 80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.
Takanori Fukushima - One of the best experts on this subject based on the ideXlab platform.
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micropatties are indispensable instruments for successful Microneurosurgery technical note
World Neurosurgery, 2020Co-Authors: Yoichi Nonaka, Naokazu Hayashi, Mitsunori Matsumae, Takanori FukushimaAbstract:Background Neurosurgical micropatties (also known as sponges or cottonoids) have been used in microsurgical procedures to protect the brain surface and aspirate cerebrospinal fluid and blood. We sought to describe unique applications of micropatties in neurosurgical interventions. Methods Various sizes of micropatties have been used in neurosurgical interventions including tumor, vascular, and skull base surgeries to enhance safe surgical procedures and clear the operative field. Their roles are divided into 3 types: tissue protectors, instrument assistants, and instruments in the microsurgical procedures. Results Appropriate use of micropatties provides a well-visualized operative field, easy identification of bleeding spots, effective tumor elevation from the cleavage layer, and precise procedures around critical structures. Conclusions To achieve safe and successful neurovascular protective surgery, micropatties play an important role in any type of microsurgical procedure in their various applications.
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instrumentation for acoustic neuroma Microneurosurgery
2019Co-Authors: Luciano Mastronardi, Alberto Campione, Guglielmo Cacciotti, Raffaelino Roperto, Fabio Crescenzi, Ali R Zomorodi, Takanori FukushimaAbstract:The most important instruments for vestibular schwannoma surgery can be grouped as follows: standard microsurgical instruments, electronic microsurgical devices, endoscopes, and intraoperative neurophysiological monitoring (IONM) devices. Standard—i.e., mechanical—microsurgical instruments are used for tumor dissection, fragmentation, and piecemeal resection. Electronic microsurgical devices consist of bipolar forceps, used to achieve precise hemostasis; handheld 2μ-thulium flexible laser fiber, which can be used for hemostasis, capsule and dural incision and vaporization, and tumor debulking; and ultrasonic aspirator, mainly used for tumor debulking and internal auditory canal (IAC) opening. The endoscopes allow direct observation of the lateral extremity of the IAC and enable the surgeon to visualize and remove the deepest tumor remnants. IONM devices stimulate both facial and cochlear nerves and detect their responses so as to offer real-time monitoring of their functional state during surgery.
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Two surgeons four-hand Microneurosurgery with universal holder system: technical note
Neurosurgical Review, 2017Co-Authors: Ali Zomorodi, Takanori FukushimaAbstract:A new technique for collaborative performance of complex skull base and cerebrovascular procedures is described. The benefits of this approach for patient safety and surgical education are discussed.
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two simple devices for Microneurosurgery automatic drip irrigating needle and a suction retractor
Neurosurgery, 1993Co-Authors: J D Day, Takanori FukushimaAbstract:Abstract During microneurosurgical procedures, frequent intermittent irrigation and/or suction are often necessary. We describe two simple devices: the automatic drip irrigating needle and the suction retractor. We have confirmed their usefulness through our routine use of these simple devices since 1982.